THE STRUCTURE OF MORBIDITY AND OUTCOMES IN NEWBORNS WITH VERY LOW AND EXTREMELY LOW BODY WEIGHT IN THE REGIONAL PERINATAL CENTER

Abstract

Introduction. The provision of medical care to children born with very low body weight (VLBW) and extremely low body weight (ELBW) belongs to the category of tertiary level neonatal intensive care (TINC) and reflects the effectiveness of regional obstetric-gynecological, neonatology and pediatric services; and the study of the structure of morbidity and outcomes in this category of newborn babies determines methodological, organizational and medical problems of the territory. The aim of the study. To assess the structure of morbidity and outcomes in premature newborns with ELBW and VLBW at birth in the setting of a Regional Perinatal Center during one year follow-up. Materials and methods. As part of the study, a retrospective analysis of 132 inpatient medical records of infants born preterm with VLBW and ELBW in the Regional Perinatal Center of the Novosibirsk State Regional Clinical Hospital in 2022 was performed. Patients were divided into two groups. Group 1 included 80 babies born with VLBW (birth weight 1000–1499 g), group 2 included 52 babies with ELBW at birth (less than 1000 g). Results. These children with VLBW and ELBW at birth are heterogeneous in the structure of prematurity, which is due to the presence of intrauterine growth retardation (IUGR) in some of them. At the same time, only the group of children born with VLBW is heterogeneous: 77.5% were registered as extremely premature, of which 63.7% were very preterm, and 13.7% were moderately preterm and 8.8% were late preterm. The category of extremely preterm prevailed among children with ELBW – 71,2%. 28% of children born prematurely had IUGR. Its structure was also heterogeneous: among children with VLBW at birth, there were equally wasty for gestational age (GA) – 15% and small for GA – 13.8%. Among children with ELBW, the small for GA – 21.1% dominated, against 5.8% – light for GA. Operative delivery (cesarean section) was chosen as the predominant method in both groups – 77.5 and 78.8% of cases, respectively. Diseases associated with prematurity were more often registered among children with ELBW at birth: severe asphyxia at birth (34.6%) vs VLBW (5%), p < 0.001; HS PDA (38.5%) vs VLBW (17.5%), p < 0.01; IVH III deg. (13.5%) vs VLBW (1.3%), p < 0.01; RP = retinopathy (32.7%) vs VLBW (8.8%), p < 0.001; severe form of BPD (23.8%) vs VLBW (5.6%), p < 0.05; NEC II-III stages (17.3%) vs ONMT (5%), p < 0.05; neonatal sepsis (34.6%) vs VLBW (12.5%), p < 0.01. The duration of inpatient treatment is 2 times higher in children with ELBW at birth: 92 ± 6.4 vs 48.8 ± 2 bed/patient days In the structure of morbidity, there were no differences in grade II IVH, PVL, mild and moderate BPD and Congenital Disorder (p > 0.05). Children with ELBW needed more treatment at birth: treatment of RP required intravitreal administration of ranibizumab (53%) vs VLBW (28.6%); surgical treatment of NEC stage III was carried out only in children with ELBW; the duration of respiratory support, regardless of the method, was longer in children with ELBW and amounted to 686.9 ± 130.3 vs 156.3 ± 26 hours . The mortality rate among all premature infants born with ONMT and ENMT was 13.6% and was 5 times higher in the group of children with ELBW who were mostly born extremely preterm. In terms of nosology, the main cause of death among all children with ELBW and VLBW is neonatal sepsis – in 50% of cases, mortality is 1.9 times higher in the group of children with ELBW at birth (38.8%) vs VLBW (20%), p < 0.05. Conclusion. The presented analysis indicates that preterm neonates with VLBW and ELBW in the setting of a Regional Perinatal Center are a rather heterogeneous group in the structure of prematurity, which, among other things, affects the formation of both extremely negative outcomes (lethal) and the structure of morbidity, the amount of care provided to them at different stages, its comprehensiveness and specialization, as well as the duration of inpatient treatment. Based on the all above, it follows, that of the entire category of preterm children born with VLBW and ELBW, the most difficult, economically costly, with prognostically worse outcomes, is the category of extremely preterm newborns.